DOL Issues Request for Information on Coverage of OTC Preventive Services

On October 3, 2023, the DOL, HHS, and IRS (the departments) issued a request for information (RFI) regarding the application of preventive services requirements under the ACA to over-the-counter (OTC) preventive items and services available without a prescription.

The RFI focuses on four key areas of information:

1. Gathering input from the public regarding the costs and benefits of requiring non-grandfathered group health plans to cover OTC preventive items and services without a prescription and without cost-sharing.
2. Seeking comment on any potential challenges associated with providing such coverage.
3. Understanding how providing such coverage may benefit consumers.
4. Assessing any potential burdens plans or health insurance issuers may face if required to provide such coverage.

While the ACA already requires non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage to cover preventive items and services, most of these preventive services require a healthcare provider to either provide a prescription or directly furnish the service. However, some preventive products are available to consumers OTC, which do not need a prescription from a provider. Examples include some tobacco cessation products, prenatal and breastfeeding supplies, and some oral contraceptives. Most health plans currently do not cover these OTC preventive products without a prescription.

Therefore, the departments have requested comments to better understand how requiring coverage of OTC preventive products may affect health plans and participants. Comments can be submitted no later than 5:00 p.m. ET on December 4, 2023.

Federal Register: Request for Information; Coverage of Over-the-Counter Preventive Services »